Endoscope‐assisted silicone plug insertion for patulous Eustachian tube patients

Ikeda, Ryoukichi; Kikuchi, Toshiaki; Kobayashi, Toshimitsu

doi:10.1002/lary.26498

Cited by 14 publications

(6 citation statements)

References 21 publications

(32 reference statements)

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“…The number of the patients in this study is relatively small to represent characteristics of PET. Moreover, patients with relatively severe PET visit our department to seek treatment including Kobayashi Plug insertion [26, 27] and injection of the ET orifice [28]. A multicenter study will be necessary to overcome these limitations.…”

Section: Discussionmentioning

confidence: 99%

The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

et al. 2019

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ObjectiveThe objective is to describe characteristics of patients diagnosed with patulous Eustachian tube (PET) using the Diagnostic Criteria proposed by Japan Otological Society, and to evaluate the efficiency of objective tests to determine patent Eustachian tube.Study designRetrospective.SettingTertiary referral center.SubjectsA retrospective survey of medical records in Sen-En Rifu Hospital identified 78 ears of 56 patients with “Definite PET” diagnosed by the JOS Diagnostic Criteria between January 2017 and December 2017.MethodInitial diagnosis, aural symptoms (voice autophony, aural fullness and breathing autophony), tubal obstruction procedures (posture change and pharyngeal orifice obstruction) and objective findings (tympanic membrane movement, Tubo-Tympano-Aerodynamic Graphy (TTAG) and sonotubometry) were evaluated. In addition, sonotubometry with postural change (Ohta’s method), sitting CT and a newly devised PHI-10 score were also examined.ResultsVoice autophony, aural fullness, and breathing autophony were observed in 93.6%, 87.2%, 78.2%, respectively. In 91% of the ears, PET symptoms improved by postural change from sitting to the lying / forward-bending position. Synchronous movement of the TM upon respiration was observed in 69.1% of the ears. Positive findings of TTAG were observed in 75.6% of ears. Positive findings of sonotubometry were found in 55.1% of ears. Sonotubometry with postural change (Ohta’s method), when the cut-off value of over 10dB was used, was positive in 45.2% of ears. Newly devised PHI-10 score representing severity of subjective symptoms classifying patients into no handicap, mild handicap, moderate handicap and severe handicap were observed in 12.2%, 10.8%, 18.9% and 58.1% of ears, respectively. The evaluation of the extent of patency of the ET by sitting CT indicated completely open, closed-short, and closed-long, in 68.6%, 11.4% and 21.4% of ears, respectively. Compared to the closed group, the completely open group had a significantly higher frequency of positive breathing autophony, positive sonotubometry, and positive Ohta’s method.ConclusionThe characteristics of main symptoms and the efficiency of various tests in PET diagnosis were analyzed based on data obtained from “Definite PET” patients diagnosed by the JOS Diagnostic Criteria. The greater the availability of tests to evaluate PET, the greater the opportunities to diagnose “Definite PET”. In particular, tests measuring pressure transmission between the nasopharynx and middle ear, such as TM observation and TTAG, are more sensitive than sonotubometry measuring sound transmission.

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Section: Discussionmentioning

confidence: 99%

The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

et al. 2019

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“…However, tympanic membrane perforation is a common complication with this technique, with reported rates from 3.8% to 17.5%. 9,10 The Kobayashi silicone plug is not available outside Japan. Jeong et al 5 developed a technique that uses an autologous cartilage chip as the plug.…”

Section: Discussionmentioning

confidence: 99%

Salvage Eustachian Tube Cartilage Chip Insertion After Multiple Transnasal Shim Operations in Intractable Patulous Eustachian Tube

Lee

Hsu

2021

Ear Nose Throat J

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This article presents 2 cases of extremely intractable patulous Eustachian tube following multiple transnasal shim insertion. These cases highlight the disadvantages of repeat transnasal shim operations, including enlargement of the Eustachian tube lumen, frequent dislocation, repeat surgery, recurrent middle ear infection, and shim misswallowing. The patients in these cases were successfully treated with Eustachian tube cartilage chip insertion through a postauricular approach. We describe the surgical technique and advantages of this promising management method.

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“…The silicone plug known as the Kobayashi plug (Fuji Systems, Tokyo, Japan) is specially made for the treatment of intractable PET . This plug is 23‐mm long and comes in several plug sizes with varying tip diameters.…”

Section: Methodsmentioning

confidence: 99%

“…The surgical method in detail was previously reported . The plug was inserted via a small incision in the anterosuperior quadrant of the tympanic membrane (TM) with local anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

et al. 2019

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Objectives/Hypothesis: To report the efficacy and safety of transtympanic plugging of the eustachian tube (ET) using a silicone plug (Kobayashi plug) for chronic patulous ET (PET).Study Design: Prospective and multicenter trial conducted in which 30 PET patients were resistant to at least 6 months of conservative treatment.Methods: The efficacy and safety of 28 and 27 patients, respectively, were analyzed. All patients fulfilled inclusion and exclusion criteria. The primary end point used the patulous eustachian tube handicap inventory-10 (PHI-10), and the secondary end point used ET function tests such as sonotubometry, tubo-tympano-aerodynamic-graphy, and respiratory movement of the tympanic membrane and auscultation of voice sounds transmitted from the nose through the ET to the external auditory canal at 3months after surgery.Results: PHI-10 scores were 34.4 AE 4.2, 6.4 AE 9, and 5.7 AE 8.6 at screening, and 3 and 6 months after surgery. Twentythree cases (82.1%, 95% confidence interval: 63.1%-93.9%) were judged as successes. There were five cases (17.2%) of middle ear effusion, four cases (13.8%) of tympanic membrane perforation, and one case of tinnitus due to surgery to remove the plug. No severe or life-threatening complications were found.Conclusions: This study revealed the efficacy and safety of silicone plug insertion for severe PET patients.

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Endoscope‐assisted silicone plug insertion for patulous Eustachian tube patients

Cited by 14 publications

References 21 publications

The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria

Salvage Eustachian Tube Cartilage Chip Insertion After Multiple Transnasal Shim Operations in Intractable Patulous Eustachian Tube

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series

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